Andrew Schulman is a New York
guitarist with a long history of playing in hotels, restaurants, small groups,
and formal concerts—even in Carnegie Hall, the White House, and Royal Albert
Hall. His memoir describes his experience as a patient in a Surgical Intensive
Care Unit (SICU), where he was briefly clinically dead. Six months later he
began a part-time career as a guitarist playing for patients and staff in that
very same SICU.

In July of 2009, Schulman underwent
surgery for a pancreatic tumor (luckily benign) but crashed afterward. He
suffered cardiac arrest and shortage of blood to his brain for 17 minutes.
Doctors induced a week-long medical coma, but his condition worsened. His wife
asked if he could hear music; he had brought a prepared iPod. When the opening
chorus of Bach’s St. Matthew Passion played in his earbud, the computer monitor
showed that his vital signs stabilized, and he survived. The nurses called it a
miracle.

Convinced of music’s healing power,
Schulman proposed that he return and play for patients and staff. He describes various
patients for whom he played over the next six years (with permission or changes
of name and details). He explains his approach to choosing music, pacing it, and
feeling hunches for what is right for a given patient. He interviews experts
and reads scientific papers in order to explain how the brain processes music. Music
reminds patients of their earlier, healthier lives; it coordinates right and left
brain; it brings calmness and peace.

Imaging studies show that music (and
emotionally charged literature) stimulate the brain regions associated with
reward—similar to euphoria, sex, and use of addictive drugs.

Schulman knew some 300 pieces from a
wide range of music, but his illness damaged his memory so that he could
recall only six of them. That meant his work relied on sheet music. Near the
end of the book, however, his “rehab” of playing three times a week, concentrating
on the music, and intending to help others—all this allowed his brain to heal, and
he began to memorize as before. Schulman consults with experts and undergoes
two brain scans and other studies that show the neuroplasticity of this brain
that allowed it to rewire and memorize once again.

Although Music Therapy is discussed
as an allied profession, Schulman is considered, rather, as a “medical musician” playing only in the SICU. Provision
of music, whether by Music Therapist or “medical musician,” is,
however, usually not covered by insurance and therefore not available to
patients.

There’s a six-page Afterword by Dr.
Marvin A. McMillen, who Schulman describes as “central” to his survival. McMillen
writes that being both a critical care doctor and a critical care patient himself
(polycystic kidney disease), he knows the importance of emotional support to
patients, healing environments, and the power of music. McMillen was also pivotal
in allowing Schulman to play in the SICU.

Suzanne
O’Sullivan is a neurologist in the British National Health Service. She has a
particular interest in psychosomatic illnesses, and in this book, she covers
what she has learned about them. O’Sullivan provides these learnings mostly
from clinical experience rather than as findings from empiric studies on
psychosomatic illnesses.

Each
chapter is built around one or more case studies that focus on particular
psychosomatic illnesses, and include historical perspectives and various
theories that might explain why they occur.
The
cases O’Sullivan uses presented themselves as seizures, paralysis, urinary
tract troubles, generalized and localized pain, gastrointestinal problems,
fatigue, blindness, and dystonia. Patients sometimes came to her with pre-determined
diagnoses such as epilepsy, Lyme disease, chronic fatigue syndrome, myalgic
encephalomyelitis, and fibromyalgia among others. O’Sullivan is emphatic that
psychosomatic illnesses are not just any presentation of illness that cannot be
linked to a pathological basis. Psychosomatic illnesses arise from “the
subconscious mind [that] reproduces symptoms that make sense to the individual’s
understanding of how a disease behaves.” (p. 83) Illness presentations that are
feigned or self-inflicted (e.g., Munchausen’s syndrome) are not psychosomatic
illnesses in O’Sullivan’s view.Each chapter delves into some particular
aspect of psychosomatic illness relevant to the case study. These include
history (e.g., role of the uterus in hysteria), mechanisms at work (e.g.,
conversion reactions, dissociation), triggers (e.g., stress, loss, personality
traits), factors (e.g., previous illness experiences), illness behavior
disorders (e.g., associating illness to benign physical sensations), and the
higher incidence seen among females. Though O’Sullivan teases out various
characteristics and workings of psychosomatic illnesses, she admits that they
remain vexing to clinicians because, “almost any function of the body can be
affected in almost any way.” (p. 170)

Wandering in Darkness is an intricate
philosophical defense for the problem of suffering as it is presented by
medieval philosopher Thomas Aquinas.The work addresses the philosophical / theological
problem of evil, which might be expressed as follows: if one posits an all-good, all-powerful God
as creator, yet suffering exists in the world, then (a) God must be evil, since
he created it; (b) God is less than all-powerful, since suffering came to be in
his creation, and he could not stop it; (c) God is evil and weak, since
suffering came to be in his creation, and he did not want to stop it; or (d)
suffering is an illusion. No alternative
is, of course, very satisfying. In her book, Eleanore Stump augments Thomas
Aquinas’s theodicy by reflecting upon what she calls “the desires of the
heart,” a dimension of human experience that Aquinas leaves largely untreated
in his consideration. Stump explores
this dimension by breathtaking exegeses of Biblical narratives as narratives: the stories of Job,
Samson, Abraham, and Mary of Bethany.
“Understood in the contexts of [these] narratives,” Stump argues,
“Aquinas’s theodicy explains in a consistent and cogent way why God would allow
suffering" (22).

A young man lies propped up on pillows, his hand pointing toward a bandaged area on his side. The composition is a powerful diagonal sweep, the body in the bed forming a triangle. At its apex, the head of the man with its mass of dark hair is haloed in the white of the pillow. His dark, glistening eyes arrest the viewer, demanding attention and implicitly evoking sympathy. Neel’s expressionism is displayed in the elongated curvature of the neck, the ears splayed out from the head to rest on the pillow, and in the eloquent gesture toward the bandage.

INTRODUCTION
Writing for
all the co-authors, Rita Charon challenges “a reductionist, fragmented medicine
that holds little regard for the singular aspects of a person’s life” and
protests “social injustice of the global healthcare system” (p.1). She gives a
history of narrative medicine, lists its principles, and summarizes the book’s chapters,
mentioning that several come as pairs that present theory then practice. The
six principles are “intersubjectivity, relationality, personhood and
embodiment, action toward justice, close reading (or slow looking), and
creativity” (p. 4). The basic
thesis is that healthcare can be improved by narrative medicine because
“narrative competence can widen the clinical gaze to include personal and
social elements of patients’ lives vital to the tasks of healing” (p. 1). This is a dense, theory-laden book from the group at Columbia University. The summaries below touch of some of the major points.

PART I, INTERSUBJECTIVITY
Ch. 1, Account
of Self: Exploring Relationality Through LiteratureMaura Spiegel and Danielle Spencer describe the richness of literature
that allows readers to respond creatively. In clinical settings, a caregiver
may similarly listen attentively and help co-construct a narrative with the
patient. Literature can help us explore “the limits of rationality and
positivism” (p. 29) and move from “a model of autonomy to one of relationality”
(p. 34).

Ch. 2, This
is What We Do, and These Things Happen:
Literature, Experience, Emotion,
and Relationality in the Classroom.Spiegal and Spencer write that current medical education
does a poor job of helping future physicians with their emotions. Clinicians profit from a
more integrated self and will listen better to patients and respond to
them.

PART II, DUALISM, PERSONHOOD, AND EMBODIMENT
Ch. 3,
Dualism and Its Discontents I:
Philosophy, Literature, and MedicineCraig Irvine and Spencer start with three literary examples
that illustrate separation of mind and body. This dualism has pervaded modern
medicine, causing losses for patients and caregivers, especially when there are
power imbalances between them. The “clinical attitude” (p. 81) dehumanizes both
caregivers and patients.

Ch. 4,
Dualism and Its Discontents II:
Philosophical Tinctures
Irvine and Spencer argue that both phenomenology
(appreciative of embodied experience) and narrative hermeneutics (privileging
reciprocal exchange of persons) help us move beyond dualism. Theorists Edmund Pellegrino
(also a physician), Richard Zaner, and Fredrik Svenaeus help us understand how
caregivers and patients should relate.

Ch. 5,
Deliver Us from Certainty: Training for Narrative EthicsCraig Irvine and Charon write that various humanistic
disciplines “recognize the central role narrative plays in our lives” (p.111).
There is, however, “indeterminacy” in stories that “cannot be reduced by
analyzable data” (p. 113). Narrative ethics urges us to consider issues of
power, access, and marginalization for both the teller and the listener. The
authors review recent ethical traditions of principalism, common morality,
casuistry, and virtue-based ethics. They believe that narrative ethics,
emerging from clinical experience and now allied with feminist and structural
justice frameworks, will provide a better approach for many reasons. “Narrative
ethics is poised to integrate the literary narrative ethics and the clinical
narrative ethics” (p. 125).

PART III, IDENTITIES IN PEDAGOGY
Ch. 6, The
Politics of the Pedagogy: Cripping, Queering and Un-homing Health HumanitiesSayantani DasGupta urges attention to issues of power and
privilege in classrooms, lest they “replicate the selfsame hierarchical,
oppressive power dynamics of traditional medicine” (p. 137). “Cripping” and
“queering” provide new perspectives on knowledge, for example the untested
binaries of physician/patient, sick/well, elite/marginalized, teacher/student.
Drawing on disability studies, health humanities, and queer politics, DasGupta
challenges “medicalization” and the “restitution narrative” (p. 141).

PART IV, CLOSE READING
Ch. 7,
Close Reading: The Signature Method of Narrative MedicineCharon stresses “the accounts of self that are told and
heard in the contexts of healthcare” (p. 157). Close reading, traced from I. A.
Richards through reader response theorists, is “a central method” for narrative
medicine (p. 164). Close reading enhances attentive listening,
and both of these deepen relationality and intersubjectivity, allowing for
affiliation between caregiver and patient (pp. 175-76). Such linkages aid
healthy bodies and minds, even the world itself (p. 176).

PART V, CREATIVITY
Ch. 9, Creativity: What, Why, and Where?Nellie Hermann writes that “healthcare in particular has a
vexed relationship to the notion of creativity,” in part because of issues of
control (pp. 211-12); values of “evidence based” and “numbers-driven” medicine are
also factors. Narrative medicine, however, “is about reawakening the creativity
that lives in all of us” (p. 214).

Ch. 10, Can
Creativity Be Taught?Hermann reports on techniques used in the College of
Physicians and Surgeons at Columbia, including prompts and a Portfolio program.
A “Reading Guide” helps clinical faculty (and others) respond to student
writing. Responses to writing can nourish the “creative spark.”

PART VI, QUALITATIVE WAYS OF KNOWING
Ch. 11,
From Fire Escapes to Qualitative Data: Pedagogical Urging, Embodied Research, and Narrative Medicine’s
Ear of the HeartEdgar Rivera Colón suggests that “we are all lay social
scientists of one kind or another,” seeing people in action in various
contexts. He affirms an “assets-based approach to public health challenges, as
opposed to a deficits-based and pathology-replicating paradigm” (p. 259). We
are all embodied actors in relationship to power, privilege, and social
penalty.
Research through interviews and participant observation show
“meaning worlds” in tension with “systemic inequality and structural violence”
(p. 263).

Ch. 12, A Narrative
Transformation of Health and HealthcareCharon presents and analyzes a case study of patient Ms. N. as treated
by internist Charon. They’ve been working together for decades. Charon writes
up her perceptions and shares them with Ms. N. Speaking together, they “became
mirrors for one another” (p. 274). Psychiatrist Marcus discusses transference
and transitional space in that experience. A caregiver as witness can
shift healthcare from “instrumental custodianship to intersubjective contact”
(p. 288).

Ch. 13, Clinical
Contributions of Narrative MedicineCharon describes applications of narrative medicine, all with the aim
of improving healthcare. She describes techniques for interviews of patients,
writing methods, and ways to improve the effectiveness of healthcare teams, as
well as changes in clinical charts and other narrative descriptions of
patients.

In the first part of this poem ("Sugar"), Dickey gives a wonderful series of images of diabetic symptoms: "I thirsted like a prince," "my belly going round with self- / made night-water," "having a tongue / of flame . . . . " The doctor preaches insulin and moderation. The poet tries to comply. He seems to accept this new life, "A livable death at last."In the poem's second part ("Under Buzzards"), the poet and his "companion" climb to a point on Hogback Ridge where they see buzzards circling. Seeing the birds of death, he reflects on his life and illness. Is all this medicine and moderation worthwhile? What will they accomplish? Regarding the body, the poet writes, "For its medical books is not / Everything: everything is how / Much glory is in it . . . . " In the end he takes "a long drink of beer."

States of Grace follows Dr.
Grace Dammann, a pioneering HIV/AIDS physician, as she navigates life following
a catastrophic motor vehicle accident that leaves her severely physically
disabled. Before the accident Grace was a devoted caregiver at work and at home.
She was the co-founder of one of the first HIV/AIDS clinics for
socioeconomically disadvantaged patients at San Francisco’s Laguna Honda
Hospital, honored for her work by the Dalai Lama with a 2005 Unsung Heroes of
Compassion Award. She was also the primary breadwinner and parent in her family
with partner Nancy "Fu" Schroeder and adopted daughter Sabrina, born
with cerebral palsy and HIV. During a routine commute across the Golden Gate
Bridge in May 2008, Grace was struck head-on by a car that veered across the
divide. She miraculously survived—her
mind intact, her body devastated. She endured a prolonged coma, innumerable
surgeries, and a marathon of rehabilitation. The documentary picks up Grace’s
story when she is finally discharged for good. She returns home to acclimate to
a radically altered life, one where she is wheelchair-bound and dependent on
others for simple tasks of daily living. The film captures the rippling effects
of the accident on all dimensions of Grace’s life—personal, professional,
psychological, spiritual, and economic—focusing especially on how Grace’s
disability turns the family dynamic on its head. Fu becomes the primary
caregiver to both Grace and Sabrina, Grace becomes a care-receiver, and as
Grace describes “Sabrina’s position in the family [is] radically upgraded by
the accident. She is so much more able-bodied than I am.” We witness her
frustrations with the limitations of her paralyzed body and see her, at one
point, arguing with Fu about her right to die if she continues to be so
impaired. Some of Grace’s ultimate goals (to walk again, to dance again, to
surf again) remain unattainable at the film's conclusion, but she sets and
exceeds new ones. Grace “comes out” as a disabled person in medicine, returning
to Laguna Honda Hospital as its first wheelchair-bound physician, where she is
appointed Medical Director of the Pain Clinic. She resumes the caregiver role,
but with an intimate knowledge of the lived experience of pain, suffering, and
disability.

Jake Jameson is
an architect who came of age in immediate post World War II London. He grew up
in “the wilderness” of the English moors and peat bogs far from London. He
returns to this wilderness with a wife and an infant son, and to where his
mother, a childhood friend, and many memories still live. We read about his
successful career, his Jewish mother and her flight from her native Austria,
his marriage to Helen and her unexpected death after about 30 years of
marriage, his infidelities, his son’s incarceration in a prison he designed,
his daughter’s death as a young child, and how eventually the wilderness he
lived in moved from the moors to his brain. We don’t learn all of this easily
because it comes in one form through Jake’s damaged memory and in another form
through the tellings of more reliable witnesses. We are left in our own
confused state about certain parts of story until the corrections and
clarifications come later in the book. For example, we can go far into the
novel thinking that Helen could have died from falling from a cherry tree until
we learn near the very end that she died from a stroke, probably.

The
collection is prefaced and named for a poem by Walt Whitman, The Wound Dresser,
annotated in this database by Jack Coulehan. In “On Reading Walt Whitman’s ‘The Wound Dresser’” Coulehan sees Whitman as a nurse
tending the Civil War wounded, and, while using some of the words and language
of Whitman’s poem, imagines himself moving forward in that created space of
caring for patients: “You remain / tinkering at your soldier’s side, as I step
/ to the next cot and the cot after that.” (p. ix) The poem introduces us to
all the ‘cots’ of the book – where we step from patient to patient, through
history and geography, and through the journey of medical training.
The
book is comprised of 4 sections without overt explanation, although there are 4
pages of Notes at the end of the book with information about select individual
poems. In general, the themes of the sections can be described as: 1.) clinical
care of individual patients and medical training; 2.) reflections on historical
medical cases, reported anecdotes or past literary references; 3.) meditations
on geographically distinct episodes – either places of travel or news items;
and 4.) family memoir, personal history and the passage of time.
Many
of the poems have been previously published and a few are revised from an
earlier chapbook. Notable among the latter is “McGonigle’s Foot” (pp 42-3) from
section 2, wherein an event in Philadelphia, 1862 – well after the successful
public demonstration of anesthesia was reported and the practice widely
disseminated, a drunk Irishman was deemed unworthy of receiving an anesthetic.
Although it is easy to look back and critique past prejudices, Coulehan’s poem
teaches us to examine current prejudices, bias and discrimination in the
provision of healthcare choices, pain relief and access to care.
There
are many gems in these 72 poems. Coulehan has an acute sensibility about the
variety of human conditions he has the privilege to encounter in medical
training and clinical practice. However, one of the standouts for me was “Cesium
137” based on a news report of children finding an abandoned radiotherapy
source (cesium) in Goiania Brazil, playing with the glowing find and suffering
acute radiation poisoning. He writes: “the cairn of their small lives / burst
open…their bodies vacillate and weaken / hour by hour, consumed by innocence /
and radiant desire.” (p. 68).
Following
another poem inspired by Whitman, Coulehan concludes the collection with a
sonnet “Retrospective.” He chronicles a 40-year career along with physical
aging, memories of medical training “etched in myelin,” and the search for
connection across that span of career including, “those he hurt, the woman / he
killed with morphine, more than a few he saved.” Ultimately, he relies on hope
with fitting understatement: “His ally, hope, will have to do.” (p. 97)

This Petrarchan sonnet of 15 lines begins as a lyric contemplation of the Norwegian sea-beast of Scandinavian mythology; but it evolves into an association of the beast with other mythological representations of invisible yet vast, destructive forces that would devour from below or swallow sojourners on the seas of everyday life. In a broader sense, then, and by means of the mythological representation, the poem may be understood as a contemplation of ideology and blind allegiances to the status quo—which lose their destructive powers only when they are recognized for what they are.